Provider Demographics
NPI:1245836188
Name:TELINTE, TESFU ABRAHAM
Entity type:Individual
Prefix:
First Name:TESFU
Middle Name:ABRAHAM
Last Name:TELINTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 N 19TH AVE APT 355
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8579
Mailing Address - Country:US
Mailing Address - Phone:520-437-5373
Mailing Address - Fax:
Practice Address - Street 1:7101 N 19TH AVE APT 355
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8579
Practice Address - Country:US
Practice Address - Phone:520-437-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ024894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist